Provider Demographics
NPI:1003367350
Name:LIONS HEART COUNSELING LICENSED CLINICAL SOCIAL WORKER, INC
Entity Type:Organization
Organization Name:LIONS HEART COUNSELING LICENSED CLINICAL SOCIAL WORKER, INC
Other - Org Name:ABLE TO
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:916-494-9218
Mailing Address - Street 1:25 CADILLAC DR #132
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825
Mailing Address - Country:US
Mailing Address - Phone:916-494-9218
Mailing Address - Fax:916-282-1698
Practice Address - Street 1:25 CADILLAC DR #132
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825
Practice Address - Country:US
Practice Address - Phone:916-494-9218
Practice Address - Fax:916-282-1698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62672104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1649478736Medicaid
CA1649478736Medicaid